Back pain and spinal cord compression: An uncommon presentation of childhood acute myeloid leukemia

Abstract

Back pain is often reported in children undergoing cancer treatment, but is not typically a presenting symptom. Spinal cord compression secondary to myeloid sarcoma (chloroma) has been described, although is rare in children. We describe a 10-year-old child who presented with thoracic back pain, which progressed quickly to complete paraplegia prior to the diagnosis of myeloid leukemia. Neuroimaging demonstrated an extradural mass at level T6 to T10, requiring emergent laminectomy and posterior decompression. Histopathology of this lesion was consistent with myeloid sarcoma while peripheral blood and bone marrow examination documented acute myeloid leukemia. He underwent treatment with multiagent chemotherapy and remains in remission. Increased recognition of ominous symptoms that suggest underlying pathology or signs of cord compression will lead to earlier diagnosis and, ultimately, minimize neurologic morbidity.

Spinal Cord Compression as Clinical Presentation of Malignant Hematopoietic Diseases in Pediatric Patients

“…All AML with epidural involvement presented t(8;21)(q22;q22)/RUNX1::RUNXT1 and FAB M2 subtype. The reported experience of our hospital in patients with AML with t(8;21)(q22;q22) and extramedullary involvement showed no differences in survival between patients with myeloid sarcoma and without this finding, suggesting that prognosis of the disease could be related to cytogeneticmolecular findings and response to treatment, more than to presence of extramedullary involvement in accordance with previous studies reported 8,16,19,[25][26][27][28] . However, preceding studies have demonstrated that spinal cord compression is the major cause of morbidity in children with systemic malignancy 6,23 .…”